Provider Demographics
NPI:1528664604
Name:BRANDT, CHARLOTTE LESLIE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LESLIE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:LESLIE
Other - Last Name:HINDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4648 OHIO ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3250
Mailing Address - Country:US
Mailing Address - Phone:951-704-9687
Mailing Address - Fax:
Practice Address - Street 1:13525 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4771
Practice Address - Country:US
Practice Address - Phone:858-486-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine